Post-Partum Depression Saga: Is This What Women Should Expect?

A woman goes to her doctor and expresses concern that she may be experiencing post-partum depression. Alarmed by the woman’s statement that she sometimes thought of hitting herself or squeezing her baby – though qualified with the statement that she wouldn’t hurt her baby – the office calls the police and the woman is escorted to the hospital, where she is held for hours. The hospital finally releases her at midnight, 10 hours after she first visited her doctor. A scene out of a dystopian novel? No, this is reportedly what happened to a woman in Sacramento, CA.

Is that what new mothers should expect when they report mental health concerns?

Care for Your Mind approached Danielle J. Johnson, MD, FAPA, Director of the Women’s Mental Health Program at Lindner Center of HOPE in Cincinnati, OH, for answers about the incident and Nancy Byatt, D.O., M.S., M.B.A., F.A.P.M., Medical Director at MCPAP for Moms about the broader issue.

The Incident

Care for Your Mind: Let’s assume that the events of that day were as reported though, to clarify, the medical staff person was a nurse practitioner, who is fully licensed as a provider. As a matter of policy and good practice regarding post-partum depression (PPD), should women reasonably expect that their provider will call the police and that they will be escorted to the hospital by police?

Dr. Danielle Johnson: If there is concern about imminent risk to self or others, providers can call the police. However, since this woman indicated that she had no intent or plan to harm herself or others – just thoughts – other steps could have been taken. The nurse practitioner could have discussed symptoms with the patient in further detail, before a decision to call the police was made. The woman’s partner, family, or friends could have been called for collateral information about her safety and state of mind so that risk factors and protective factors could be taken into account in making a determination about next steps to take.

CFYM: Is there a way that medical providers might handle concerns about PPD that factors in health of the mother and the baby, particularly in a way that is consistent with shared decision making?

Dr. Johnson: [If the facts in this case are as presented,] this woman should have been screened for safety and the nurse practitioner could have obtained more history about her symptoms. Administration of an EPDS (Edinburgh Postnatal Depression Scale) could have helped to determine the severity of her symptoms.

If, after an appropriate assessment, there was concern about safety and police still needed to be called, another clinic might have called her partner/family/friend to pick up the baby instead of baby having to also be escorted by police. The police escort for the baby likely caused the mother to feel worse about herself, particularly as a mother.

Not every woman with PPD is a danger to herself or her baby; most are aware and they would never act on any intrusive thoughts. If police are not needed because no imminent threat exists, the doctor and patient (and ideally the family) should discuss medication and therapy. They should also develop a safety plan with family in case the mother’s symptoms worsen and she becomes unsafe. Providers should keep in mind that many women feel embarrassed, ashamed, and guilty, so when they seek help, they need compassion and not made to feel like a criminal. We have an obligation to make sure our patients are safe. We can usually do that without resorting to law enforcement and involuntary hospitalization. I believe that this scenario could have been handled differently.

Editor’s Note: There are now multiple bills pending in the California State Assembly to provide better identification of and care for postpartum depression.

Your Turn

What process would you want your doctor’s office to follow in screening for postpartum depression?

Who should be responsible for assessing a mother’s risk of harming herself, her baby, or others, and why that person?

BioDanielle J. Johnson, MD, FAPA, is Chief of Adult Psychiatry and Director of the Women’s Mental Health Program at Lindner Center of HOPE in Cincinnati, OH. Dr. Johnson completed her General Psychiatry Residency and Psychiatric Emergency Services Chief Residency with University of Cincinnati College of Medicine and University Hospital in Cincinnati. As a staff psychiatrist for Lindner Center of HOPE, Dr. Johnson’s interests include treatment of mood disorders, anxiety disorders, psychotic disorders, and ADHD in the inpatient and outpatient settings. She contributed to the development of the Women’s Mental Health Program at Lindner Center of HOPE. Dr. Johnson is a member of the Marce’ Society for Perinatal Mental Health, and Postpartum Support International. She is included in the MedEdPPD.org Provider Network after completing training in the assessment and treatment of postpartum mental illnesses.

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We know that when young people are in distress they commonly turn to friends for help and support. We decided to try to figure out how to use this idea more effectively.

The background
Central to JED’s work is our Comprehensive Approach, which includes (1) taking actions to identify those in a community who may be at risk and (2) supporting efforts to increase help-seeking among those in distress. We continuously seek to educate young people about mental health problems as well as how they can respond effectively to these problems when either they or a friend experience them. We needed answers to these questions: